Do young patients with dyspepsia need investigation?

During 1986, 1386 patients with simple dyspepsia were referred by general practitioners for endoscopy (686) or double-contrast barium meal examination (700) at Leicester General Hospital. 618 (45%) were under the age of 45 years. Abnormal findings were more common in older than younger dyspeptic patients (58% vs 40% at endoscopy, 69% vs 25% by barium meal). Malignant disorders were diagnosed in 5% at endoscopy and 3% at barium meal, but in no patient under 45 years old. The incidence of malignant disorders at endoscopy was analysed for the 6 years 1980-86. Of 707 cases identified, only 13 (1.8%) occurred in patients under 45 years old; all 13 had symptoms suggesting pathology more serious than simple dyspepsia. It can be concluded that young patients with simple dyspepsia are overinvestigated. A majority can be treated safely with antacids and/or histamine receptor type 2 antagonists.